Nedunchezhian, V (2020) A Comparative study Between BISAP Score and APACHE II Score in assessing the severity of Acute Pancreatitis based on the Revised Atlanta Classification. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : Acute pancreatitis is the most common gastrointestinaldisease for which patients are acutely hospitalized. Around 80% of patientswith acute pancreatitis have a mild disease course wheresymptoms usually resolve within 1 week.Approximately 20% of patients develop severe acute pancreatitis withorgan failure and/or necrotizing pancreatitis. Necrotizingpancreatitis is defined by pancreatic parenchymal necrosisand/orperipancreatic fat necrosis.Those patients areat risk for a persistent systemic inflammatory responsesyndrome and/or (multiple) organ failure. Sterile pancreaticnecrosis and sterile peripancreatic collections canusually be treated successfully with conservative measures.However, 30% of patients develop secondary infection ofnecrosis, most often 3 to 4 weeks after the onset of disease.When secondary infection of necrosis occurs, morbidityand mortality increase dramatically.Overall mortalityin severe pancreatitis is high (15% to 30%) comparedwith mild pancreatitis (0% to 1%). AIMS AND OBJECTIVES: To Evaluate the Efficacy of BISAP score and APACHE II score to Assessing the Severity and Mortality in Acute Pancreatitis based on the Revised Atlanta Classification. Stratification of the patients with Acute Pancreatitis according to their scores at the time of hospitalization. Thereby to Predict the Appropriate Point for Early and Timely Intervention. METHODS: First 100 patients with Acute Pancreatitis included in the study. APACHE II and BISAP scores were calculated by using the APACHE II prognostic system in the manner described by KNAUSet. Al and the cardinal health database system for BISAP scoring and Recorded within 24hours of admission to the hospital. Patients were classified to have Mild or Severe Acute Pancreatitis according to the Revised Atlanta classification guidelines. APACHE II score of more than or equal to 9 and BISAP score more than or equal to 3 are expected to predict the severe acute pancreatitis. Patients were observed prospectively until discharge or death. RESULTS: In this study acute pancreatitis more common in males. Male female ratio in our study is13.3:1.the mean age was 42 years and the mean length of hospital stay was 11 ± 5 days.The most common presentation was predominantly abdominal pain (100%), followed by vomiting (60%), abdominal distention(59%)& other manifestations. In this study, 76 patients were diagnosed to have mild acute pancreatitis and24 patients found to have severe acute pancreatitis. The ROC analysis to assess the severity in AP by BISAP score has AUC of 0.947, sensitivity 100%, specificity of 89.47%, PPV of 75%, NPV 100% and diagnostic accuracy of 94.74%;whereas APACHE II score has AUC 0.822, sensitivity of 75%, specificity of 89.47%, PPVof 69.23%, NPV of 91.89% and diagnostic accuracy of 82.24%. The ROC analysis for prediction of mortality by BISAP and APACHE II score hasrespectively AUC (0.858,0.679), sensitivity (100%, 60%), specificity (71.58%, 75.79%), PPV (15.63%, 11.54%), NPV (100%, 97.30%) and diagnostic accuracy (85.79%, 67.89%),This matches well with B U Wu et al41, Papachristou et al1, where specificity (87.6%,65.7%),PPV (15.4%, 10.8%), NPV (98.1%, 100%), for BISAP and APACHE II scores, respectively. Thus by using Chi2 test, BISAP ≥ 3 was found to be significantly associated (p < 0.007) withhigh mortality than APACHE II score by ROC. In this study, 3% patients developed acute renal failure, 5% patients developed MODS, 5%patients developed septicemia and 11% developed other complications like ARDS, UI bleed,Hypocalcemia etc. Remaining 86% of them not developed any complications. CONCLUSION: The BISAP score predicted the severity and mortality significantly over the APACHE IIscore in patients with severe acute pancreatitis.From this study, we conclude that the BISAP score could be a simple andaccurate clinical scoring system for the evaluation of disease severity in acutepancreatitis.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711060 |
| Uncontrolled Keywords: | Acute Pancreatitis, BISAP (Bedside Index for Severity in Acute Pancreatitis) score, APACHE II (Acute Physiological Age and Chronic Health Evaluation) score, Revised Atlanta classification. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 01:36 |
| Last Modified: | 09 Feb 2021 01:36 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13947 |
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